In practice we are asked whether anti-pronation running shoes or orthotics are the best option for runners. This article will help you to understand pronation and guide you in your choice of running shoes to prevent over pronation.
Pronation describes the rolling in of the foot as it strikes the ground during walking or running. This rolling in is part of the normal mechanics of the foot. It allows the foot to absorb energy efficiently and reduce the impact forces up the leg and into the rest of the body.
For some people the foot will pronate too far, too fast or both. These situations will give rise to increased risk of injury as the impact forces will be greater and the stress on the supportive structures (muscles and ligaments) of the leg and low back will be increased.
Do This exercises to understand the mechanics better.
From this you can get a picture of what is happening to the movement of the joints in the leg. This is called a kinematic chain as it describes a chain of movement.
Go to any running shop and pronation will be on the radar. Since the 80’s running foot wear has been developed to help cushion and stabilise feet and pronation has been seen as the enemy. This approach sprang up following research that linked over pronation to running injuries. Further research corroborated this and manufacturers responded to prevent pronation. This lead to various approaches to aid stability at the ankle. The footwear had increased arch supports or a cant to change the angle of impact or both. This lead to a heavy and bulky shoe.
However, it is important to remember that the foot is supposed to pronate as part of shock absorption and normal mechanics to allow the foot to flex during the heel strike to toe off phase of gait. Stopping this is equivalent to trying to run on a stiff leg or stump. That is not going to help your prevent injury and may even make things worse. So it is important to maintain a balance that reduces excessive pronation and slows its rate if you roll in too fast.
Runners with feet that over pronate will generally need an anti-pronation shoe or an orthotic, runners that have high arches (supinate) will need a better padded shoe.
In 2001 Benno Nigg (1) proposed a new way of thinking on how these measures work. Rather than assume that they changed the position of the foot he postulated that they changed the pattern of firing of the muscles of the leg. This then created the stabilisation and slowing of pronation. This makes perfect sense as it is the firing of muscles in a coordinated fashion that stabilises and moves a joint. However as we saw in the exercise earlier the knee, hip and pelvis position also affect the ankle. So in order to achieve good ankle stability you also need top strengthen them.
A key muscle in this process are the Gluteal muscles. They stabilise the hip when you stand on one leg stopping the pelvis from dropping forwards on that side. Remember as the pelvis drops forwards it rolls in your ankle.
So in summary, if you want to run well, get your pronation assessed, select the appropriate stabilisation and strengthen the muscles around the hip, knee and ankle by following these exercises.
You may now be able to guess what I recommend to help the problem. In my opinion an orthotic in a neutral shoe is a good option. HOWEVER, it needs to be the right type. It should have an arch that is free to spring and not be a solid inflexible device such as the moulded bespoke carbon or plastic varieties that have little or no give in them.
Similarly it shouldn’t be a foam based orthotic that fills the arch up. Now if you look at the anti-pronation shoes they basically tilt or cant the shoe to take out some of the roll. The problem with this is the lack of spring but also you have a clumpier, heavier shoe to carry round for your 40000 steps. That extra bulk and weight will have an effect after that many reps.
At Back In Form we recommend SOLE orthotics as they give the spring required and they are relatively inexpensive when compared to tailored orthotics. If you’d like us to assess you or for more information on how you can save over 10% off RRP just call us on 01202 733355.
It had never been my intention to do an Ironman in September in 2017 as I had wanted the late summer off. However the Lanzarote experience (food poisoning) had forced me to seek another one out and as it was the first event in Italy, and the food is so good, Karen was keen to get me to sign up.
So we arrived a few days before and settled into the hotel and the great atmosphere these events generate. Despite my gastronomic disaster last time I still played shellfish roulette at dinner. It wasn’t much of a risk as you could toss the shells and hit the fish market behind if you wanted.
The day of the race was perfect. Smooth warm water and a gentle breeze. I had sought out my first ever swim lesson 2 weeks before and this paid dividends as I was 3 minutes faster than my PB. So I was up for it, the target was a sub 10:30hr race, previous PB was 10:53. However the transition was over a kilometre long and the bike was 5k longer than usual so that was a big ask. Still nothing ventured nothing gained.
As I had exited the swim fairly quickly I found myself in a fast group of riders who initially worked together within the rules (no draughting) and the pace was high. However some soon started to realise that two brits, me and a chap called Duncan were pushing on and they started to draught. In fact there was a lot of draughting. This is very annoying as it wears you out but rests the opposition. So I had to pace myself to not be spent when the marathon started.
To make matters worse the top of my water container popped off and I was getting covered in sticky drink which should have been going into my stomach! Any small loss of hydration can have serious effects on performance. It also makes it hard to eat your food. This cost me time and I lost the quick group.
By the time I finished the bike I felt as if I had made up the deficit and my legs felt good as I ran up T2 with the bike. A quick change and I was off on the run with an expected finish time of sub 10 hours. I was feeling great and stoked by the time. Karen was cheering me on fervently and we were in for a good one.
That is the biggest mistake Ironman Triathletes make. They get carried away and run off too fast. First 10k, flying along (for me) at 8 min miles, next 10k just a little slower then BOOM my quads went tight and I was struggling to run. Stretching nearly gave me cramp so I gave that a miss and it was shuffle, jog, walk, curse, question my sanity at doing something so crazy such as entering and then being stupid to not run enough in training.
It’s tough being in the mind of an exhausted person when you still have a half marathon to race. You want to stop and give up. You want to swap places with the person being pushed around the course in a buggy. Wait a minute. Did I just see that or am I about to collapse? No I was not hallucinating. There really was a team who had swum with a less abled chap in a rubber dinghy for 3.8k, then towed him on a bike for 185k and now there they were, on the run smiling. Yep, smiling. I couldn’t give up now, so it was gels and flat cola by the bucket load, plenty of thigh slapping, swearing and gradually my legs returned.
With a huge effort I started to run continuously and pick up the pace again. I was hopeful that my target of 10:30 was still on but as I got to the final 5k I realised that was long gone. The next target was a PB of sub 10:53 and I managed to get to the line (which you feel may never come) in 10:42. Respectable, but could have been a lot better if I had paced my run. The run came in at 4:05 which was only 4 minutes slower than last year when I ran all of it. So I really had been the hare when I should’ve been the tortoise.
I am not doing a big one next year as life is likely to get a little too busy, but I can manage a couple of middle distance Tri’s and may have a pop at Time Trialling on the bike.
I had trained all winter, braving freezing dark evenings, plus bleary eyed pre dawn starts in the pool. May had come round all too quickly and it was time to head off to Lanzarote for the Ironman. Unfortunately, some under cooked chicken put me out of action for 5 days and so the less said about that the better. To rub salt in the wound it was my Birthday too, so not a great trip.
That left me eager to make amends at the Titan Brecon. This is a race in the Brecon Beacons and a half distance but a tough one. So I was ready for it, however it was also the hottest day of the year which proved a problem on the run.
I was doing pretty well overall, lying in 19th place after the bike. The heat meant that I ran out of fluids just before the big hill climb with a further 10miles of the bike to go. This left me dehydrated for the start of the run. The result was cramp setting in hard in both legs at mile 3 out of 13. Add in shade temp of 33c and you had a recipe for a true endurance test.
The result was that I had to keep stopping to gulp down lots of water at every chance plus pouring it over myself. In the end I gave up on a PB time and ended up getting to know some of the helpers quite well. So another disastrous race, only plus side was the pro female winner was also 15 minutes slower on her run than usual too.
The next big one was Weymouth Middle, after a bit of argie bargie in the swim that nearly saw my goggles go floating off it was onto the bike. My glasses rapidly misted up and I was riding practically blind up the first big climb. I managed to pick off quite a few of the faster swimmers and was well placed on my return to T2. It’s always a good feeling to see the leader still only just on the run as you come back into town. I also had my number one support crew of Karen and our friends’ dog Hero to encourage me.
The run went quite well and I managed to overtake a couple of runners ahead of me but was past by one other. The aim then was to keep him in sight and hope he fatigued. It was close at the end with him only 40m ahead of me. However I just didn’t have the legs to catch him in the final sprint so finished in 11th place overall, just 1 minute off 5 hours overall. So close. Still the home made organic speciality ice cream after was a real highlight!
July saw me fall off my MTB and slice my knee so the next race suffered from lack of training, less said the better. August was back to Swanage where my lack of training showed and I came in at my usual time of 2:30. A week later was a trip to Weymouth for the classic Tri. Despite my running being off parr I managed to go 4 minutes faster than 3 years previously, so I was quite pleased with that. The next step was Ironman Italy which you can read about here.
If you were asked ‘how is your sense of balance?’ how would you reply?
For many people their idea of good balance would be whether they are good at walking along a wall or narrow beam, or if they are comfortable to go up scaffolding and clamber around on a roof. Indeed, these things do require a good sense of balance but day to day we all need our balance systems in order to know where we are in space when just sitting or standing still. Even more so to stand up from a chair and simply walk across a room, let alone turn around.
Now, when our balance is acutely disturbed we can experience a feeling of spinning (vertigo) or falling. There are various different reasons for this including alcohol, which is particularly toxic to the cerebellum, (the area that is associated with balance and co-ordination), is just one reason. Think of the clumsiness , slurred speech and stumbling of someone who has had a few too many.
When those changes are more gradual or a subtle loss of balance we may not even realise we have a problem.
Our brain and body will do its upmost to compensate but these adaptations can result in changes of posture and maybe spinal problems. Slowing of general movements occurs. Walking speed is a common sign as are changes in tolerances of movement around you, this can manifest as travel sickness or feeling uncomfortable in supermarkets and busy streets.
Another common complaint of people with giddiness, dizziness or balance issues is anxiety and nausea. It is estimated that 15-35% of the population will experience a complaint of dizziness and at least a third of those will develop a secondary psychological disorder. (Ref: Susan Herdman PT, PhD Vestibular Rehabilitation 2nd Ed)
Are you noticing these changes in your balance, co-ordination, speed of movement or someone else’s .
Do you think you might benefit from having your posture, balance and co-ordination checked? Chiropractors at Back In Form are trained and practiced in looking at the integration of these systems and may be able to improve or resolve your complaint with treatment and ‘vestibular rehabilitation’. If you’d like to know more then please call the clinic for further advice or to make an appointment.
“I like a challenge”. That would probably be the best way to explain why I have found myself doing Triathlons. That and the inevitable accusations of being in the grip of a perpetual mid-life crisis!
Triathlon keeps me fit and helps me feel good about myself. It helps me understand the needs of athletes and the training methods to stay faster for longer. To be fair I’ve always liked cycling. Mainly mountain biking really as a kid and young adult. I used to be good at cross country at school, until I hit my late teens then got distracted by the bright lights and excitement of going out.
Following a fairly significant car accident I started swimming to strengthen and rehabilitate my injured neck and upper body. Then I just decided it would be good to tie them all together and do a triathlon. A patient of mine talked me into it and so a motley crew, with me being the youngest, headed off to Mallorca for my first attempt. I had my heart set on sub 2hours 30mins for my first one. I finished in less than 30 mins! Lack of preparation and a complete failure to realise that I was in the company of some serious international athletes lead to me running into the fairly rough sea with the top boys who were all there for some pre season training.
I’m not ashamed to say that I was swamped by what seemed like those scenes of wilderbeast crossing a crocodile infested river. Every time I tried to get a breath I was under again. Add in the espresso coffee, tight suit and rough seas and it rapidly went to disaster. Trying to breath a good part of the salty Mediteranean lead to my first and hopefully last ever panic attack type experience. I simply couldn’t breathe. A brief stop on a kayak followed and then on I went. Only to be offered a rescue from a rib. It was too tempting and I abandoned as I wasn’t going to get my time and all rational thought had gone when I couldn’t breath without coughing due to a mild bronchospasm. Not being allowed back in to get my kit from transition meant I had to stand in my revealing Triathlon suit in the middle of a foreign town. That was enough to make me think more carefully about how to achieve a better result.
So having been told I had a talent by one of our fellow competitors ( before nearly drowning ) I thought I’d have to prove him and me right. The following year, with a little more training I started my Olympic triathlon events with a nice hilly one in the Purbecks at Swanage. I got off to a good start coming out of the water in around 23 minutes. Then I was off on my bike and managed to stay ahead of those following who didn’t have Time Trial bikes. Things were going well and I started the run in a good position. However…I hadn’t done enough running. After climbing the big hill at the Obelisk on Ballard Down and stretching out for the descent, Hamstring number one cramped. It was like being shot! A quick stretch from some passing walkers and I was off again…..for 20 yards, bang the other one went!!! Further stretching, lots of swearing and I was off again, albeit slower. People soon were passing and I couldn’t do a thing about it. The end result 2hours 32 minutes, Dammit!!
A month later I got cramp at the second transition and that was after a fast bike where I lost my chain. I then tripped on my kevlar laces and bashed my knee. Bloodied but undeterred I hobbled round the course and finished in 2 hours 30mins and 11 seconds. Gutted. So next stop Portsmouth, flat course and closed roads helped me complete in 2 hours 27 and a few seconds. Not bad.
Next stop half ironman, however Glandular Fever got me last year and I couldn’t compete at all. So now I have the big year of doing two half ironmans and the full monty in Mallorca, plus Portsmouth where I would like to be at least five minutes faster. Hopefully, if I just follow my own advice that can be done, the question is will I keep coming back for more?
2015 Season Update.
Over the winter I struggled to get up in the mornings for a swim but I did manage to get out on the bike several times for long rides, even on icy roads in January. So the base level was good for my first half-ironman in the Brecon Beacons. I expected a cold swim in a lake but it was a balmy 18 C. The swim went OK except the lake was shallow and two laps meant you got a good mouthful of muddy water! Then onto the bike which was pretty chilly initially. The wind was a bit tough and the large 400m hill towards the end had to be hit hard as thats what I like to do on hills. I overtook a lot of guys but paid for it on the run. My old nemesis cramp got me again with only 12.5 miles out of 13 still to run. So I didn’t do a blistering pace but finished the event in a reasonable position.
A week later it was off to Ironman UK 70.3 in Exmoor. It was bleak weather and blowing a hooly. The swim went well and it was onto the bike. I managed to keep up a good pace for the first lap but slowed a bit on the second. So my pacing was out. The course was tough. Very hilly so as I started the run my legs were already quite tired but I set off at a good pace. Then once again as I started to go downhill my right Hamstring cramped again! It was then the usual story of managing cramp which set off every time I went downhill, and there were a lot of hills! So my target had been sub 6 hours. I was still on for that time until the last lap when my legs just seized. I couldn’t even move for a minute. I managed to gradually nurse the legs back and made it home in 6:02. Disappointing.
So the main problem for me was cramp. I had 3 months before Ironman Mallorca to work out how to stop it. As everyone knows a lack of salt leads to cramp, but how to judge how much to have. Time to bring in some Chiropractic and Nutrition knowledge to banish this demon.
Mallorca Ironman 2015:
Woke up to dry conditions after fitful sleep. Partly due to the awful hotel entertainment keeping me awake. A mistake not to be repeated. The swim was a rolling start so managed to stick with a good pace. No repeat of the previous Mallorca Triathlon this time. I exited the water in 1:06 then remembered to start my Garmin watch! Teething problems again. Transition was relatively smooth and off I went. I was managing to stay ahead of most of the normal bikes but there were some amazing bikes passing which would have helped. Sticking by the rules and not draughting I used my knowledge of the mountain part of the course to good effect but was starting to fatigue towards the end. However this time I was taking the salts on board as well as the home made granola flapjacks. That wasn’t such a good idea. The bag became a big blob of sticky nuts and seeds and eating it slowed me down. I also needed back pockets to keep it in. Not very Aero. So overall an amateurish approach. More lessons learnt. T2 was a slow affair, I didn’t want to forget anything and needed a bit of time. Then it was off on the run in 28 degree heat in the shade. It was hot. I tried to stay in any shade I could find and bouyed on by the support of the crowd who were quite entertaining at times I ran, jogged and then shuffled my way round. There’s a small bridge on the course and by lap 3 and 4 I was walking up and down that. Eventually when you felt you couldn’t take anymore the finish came in sight and I got over the line in 11:40. Not bad and ahead of my target of 12 hours. So I was very pleased and encouraged to keep going.
In August our amazing Olympic team brought home life time best performances and medals galore. The joy and delight on their faces was moving and something you can share to an extent by joining the para-olympic athletes as they inspire even more through their heroism in the face of adversity.
The common theme from the Rio games is one of inspiring the next generation to compete, but what about the current and former generation? Yes that’s us lot, who have probably been mainly sat on the sofa while watching, possibly with a glass of wine and a few crisps and nibbles. Well, we all need a break from the usual bad news don’t we?
But why not participate yourself next time you settle down to watch some sport. You could do a stretching routine or even some floor exercises and feel the burn with those on the screen. I’ve been doing it for F1 for years as it stops me falling asleep, even on the highlights program!
If that seems a little too much there are exercises you could do while barely leaving the sofa. Here are a few to help you.
The Technical Bit:
Anti-Cholesterol drugs such as statins reduce your cholesterol by slowing down the production of cholesterol by the liver. They do this by interfering with the action of a key enzyme, HMG-CoA-Reductase. Cholesterol production is not fully blocked nor is the production of other substances that are derived from the same pathway, such as steroid hormones and vitamin D.
Because cholesterol synthesis is reduced, the liver takes up more cholesterol carrying LDL particles from the blood. The net result is a reduction in circulating LDL-cholesterol (bad cholesterol).
Statins also help to stabilise the fatty plaques (fatty deposits or atheroma) within the lining of the arteries. This is why people who are at high risk of heart disease or stroke or who have diabetes, may be prescribed a statin even if they have a normal cholesterol level.
There’s no doubt that a healthy lifestyle helps lower cholesterol. The question is whether it can lower your levels enough – and that depends on how high your levels are and what your doctor has set as your goal.
Eating a heart-healthy diet can lower LDL cholesterol at least 10%. If you lose 5% to 10% of your body weight, you can cut LDL cholesterol 15%, and reduce triglycerides 20%. If you exercise at a moderate intensity — meaning you have enough breath to talk but not sing — for at least 2 ½ hours a week, you can further cut triglycerides 20% to 30%. (Exercise can also increase your HDL, the “good” cholesterol.)
That’s a great start, says Michael Miller, MD, director of the Centre for Preventive Cardiology at the University of Maryland Medical Centre. “Lifestyle changes certainly are the cornerstone of cholesterol reduction.”
Of course not. Doctors say the best way to protect your heart is to make healthy lifestyle changes while taking a statin. I say the best way is to make healthy lifestyle changes and avoid the statin unless you are diabetic or have recently had an acute cardiac event.
If you look at the medicine supported websites you’ll see the following:
Like many pharmaceutical drugs, statins can have body wide side effects and may also interact with other medicines you take. potential side effects can include:
Did I just hear that right? 60% of people on statins get no benefit from reduction in heart attacks! I wonder what the figures are for reduction in heart attacks by adopting a healthier lifestyle. When you consider that 9% of people on statins will get adverse effects on every cell in their bodies. This is due to a reduced ability to release energy from the mitochondria (the powerhouses of the cell) due to the reduction of Co-Enzyme Q10. This is well documented to adversely affect muscle, but it can also lead to fatigue of nerves too. However some studies have found that Statins may help improve dementia. These studies however are not high quality and further research is needed. (3)
When I see data like that and patients who are stiff and ache all over I begin to question if this reliance on statins is worth the loss of quality of life for at best a 40% reduction in CV events. I also wonder why time and time again patients who are on statins don’t get advised to take Co-enzyme Q10 when statins adversely affect your ability to produce energy through the inhibition of Co Q10.
Here’s another little known fact. After a year of taking Atorvastatin any increase in HDL (the good fat) is gone and in fact a reduction in the good fat from the starting baseline is often found. It is also noted that the first dose is the most effective, subsequent increases in dose have a much reduced benefit at 6% reduction in LDL as opposed to around 50% for first intial dose.
If your GP recommends that you go on a statin and you have struggled with commonly associated significant stiffness aches and pains; there are alternatives available. Colesevalam is a statin that works more specifically at a “gut level”, so does not produce side affects of muscle and joint pain and stiffness. It can for some however cause constipation and flatulence. So neither is perfect but may be a more favourable solution. It is however much more expensive that a generic statin.
Here’s a viewpoint from a GP;
The important bits: Nice (the National Institute for Health and Care Excellence) has issued guidance that proposes reducing the cardiovascular primary prevention risk threshold – the level of risk at which statins can be prescribed – from 20% to 10%. In other words an increase in prescribing of statins.
In May 2014 a national conference of general practitioners passed a unanimous motion calling for Nice to recommend such changes only on the basis of a full disclosure of trial data. This was followed in June by an unprecedented open letter to Nice (click link to read) from a number of senior doctors and academics expressing four main areas of concern: medicating healthy people; non-disclosed side-effect data; relying on industry-funded statins trials; and conflicts of interest within Nice.
There needs to be more transparency with respect to statins. Eat a diet high in good fats and lower in bad fats. There is plenty of info out there and we will add some suggestions in the near future.
A viewpoint on statin effects – benefits and problems Thomas F Whayne, Jr, MD PhD FICA Int J Angiol. 2008 Winter; 17(4): 178–180.
Coenzyme Q10 and statin-related myopathy. Drug Ther Bull. 2015 May;53(5):54-6. doi: 10.1136/dtb.2015.5.0325.
Statins and cognition: a systematic review and meta-analysis of short- and long-term cognitive effects.Swiger KJ1, Manalac RJ, Blumenthal RS, Blaha MJ, Martin SS. Mayo Clin Proc. 2013 Nov;88(11):1213-21. doi: 10.1016/j.mayocp.2013.07.013. Epub 2013 Oct 1.
Take a look in a full length mirror at yourself and see if the following applies to you.
A commonly seen aberrant posture in clinic is one where your foot is turned out, the arm on the same side is held slightly flexed at the elbow and is rotated inwards so that you can see more of the back of the hand than the other side when looking face on. The same shoulder will also be held forwards. Typically this is due to weakness of the anti-gravity muscles down one side of the body and is a milder presentation than Pyramidal Weakness found in some typical stroke patients.
The anti-gravity postural muscles hold the shoulder back and rotate the arm outwards. They also lift the leg and foot from the floor. Commonly this pattern of weakness leads to rotator cuff problems, tennis elbow, hip pain, shin splints etc. If you have had any of these problems or get them repeatedly despite having had treatment then you possibly have a functional weakness of a relay area in the brain called the Ponto-Medullary-Reticular-Formation or PMRF for short.
You can have as much Physiotherapy, Chiropractic, Osteopathy or whatever other therapy you like, but if the weakness is established the problem will keep recurring. Why? Because the brain will keep pulling you into the poor posture. If you are exercising and getting stronger you will have less symptoms, but push it hard and you’ll be likely to get your injury again. This is because the area in the brain will fatigue one side faster than the other and your control will diminish. The result, yet another injury. Just think how many sports people have struggled through their careers with hard to treat injuries. The list is endless.
By specifically treating to enhance function in this area we can help to restore normal function. If we combine this with visual exercises we can help to hard wire the pathways to strengthen them. This requires repeated stimulation over a short period to get the nerves to express genes that lead to growth of new connections. It won’t happen without repetition.
So if you’ve ever had a car accident or a whiplash type injury from sports such as horse riding, skiing, boarding and obviously boxing then you may be prone to these problems. If you’ve ever had a concussion or been knocked out the chances of this are significantly increased.
Make sure you find someone who can look at these patterns to help you for the longer term and not just a quick fix.
If I asked you what was the most important vitamin for fighting colds what would your answer be? Many people think it’s Vitamin C. It is certainly important in helping to mop up free radicals which cause damage through a process known as oxidative stress, but it’s not the most important. Vitamin D3 has been shown to boost immune function thereby helping you fight the invaders before they get a foot hold. To put it another way, Vitamin C helps you fight the effects of the chemicals released by inflammation, vitamin D3 helps to stop it in the first place.
Vitamin D3 is synthesized in the skin when exposed to sunlight. Vitamin D2 is found in plants. Vitamin D has long been known to support the absorption of calcium and formation of bone. A deficiency leads to softening of the bones and Ricketts (bandy legs). This disease is on the increase again, due to people covering up for cultural reasons and lack of sunlight in higher latitudes, especially for those of darker skin.
More recently Vitamin D3′s role in immune function regulation has been studied extensively and new research is confirming it’s importance as a vital supplement. Poor immune function obviously can leave you more susceptible to infections such as the common cold and flu. It can also reduce your ability to recognise and destroy cancerous cells, and can lead to the development of auto-immune disorders where your immune system actually attacks your own body. This process has been implicated in some inflammatory arthritis, multiple scerosis, systemic lupus. A correlation has been found between low levels of Vitamin D3 and all of these disease processes. In addition macular degeneration (blindness), hayfever, chronic rhinitis have all shown signs of being affected by low vitamin D3 levels.
This depends on your location, skin colour, diet and sun exposure. In the UK 90% of the population are below recommended levels. 75% of young adults are deemed deficient. 20-40% of young adults 19-24 years old, care home residents and children of British Asians have been found to have only a third of recommended levels. The amount needed varies according to who you read, the Endocrine Societies Clinical Practice Guidelines state from 400 iu to 800 iu as a daily requirement. With an optimum of 1000 iu to 1500 iu. In cases of deficiency 2000iu to 10000iu. You can read the guideline here. One thing is clear, if you are wrapped up for several months of the year in low sunlight you won’t be getting as much as in the summer.
Is this why you are more likely to have “bugs” in the winter? Is it also why cancers such as colo-rectal cancer are more common at higher lattitudes? There is also a possible link between latitude and multiple sclerosis and diabetes. Also have a look at this site which has a good deal more on the topic.
Natural food sources are oily fish, such as salmon and sardines and eggs. It is also in fortified cereals, spreads and powdered milk. The NHS site states that most people should have enough, but latest clinical guidelines dispute this. Supplementation should be 1000iu for babies and children (be aware that baby formula milk commonly contains vitamin D, so adjust accordingly). 1500-2000iu for adults 18+ years of age.
Generally because vitamin D deficiency is so widespread in the UK routine measurement is deemed unnecessary. A more cost-effective approach is routine supplementation with sensible sun exposure in the spring summer and autumn. High risk groups should be screened, these include people at high risk of inflammatory bowel disease, cystic fibrosis, gastric bypass patients and patients taking medication that effects vitamin D metabolism (anti-seizure meds, glucocorticoids, AIDS meds).
Historically there have been concerns as very high levels can be toxic and cause too high a level of calcium and phosphate in the blood leading to bone conditions. However it is now well established that toxicity is extremely rare. Doses of up to 10,000iu a day have been used for up to 5 months with no adverse effects, suggesting that only long-term over supplementation is an issue. However it is important to stick to the guidelines.
If you live in northern latitudes, are inside alot and use sunscreen extensively you won’t get enough from the sun. Especially with our weather!
There are many products on the market, I would recommend a natural food source variety and not a synthetic one. A quick search online should provide a wealth of information to help you choose.
GPs are being advised to only use short courses of steroid injections to treat tendinopathies, after a systematic review found using them for longer can produce worse results than no treatment.
Instead they are being advised to use other methods of non-steroidal injections for treatment such as botulinum toxin and hyaluronic acid for conditions such as tennis elbow and other tendinopathies.
The extensive review – published in The Lancet – looked at 41 trials involving 2,672 patients and estimated the standardised mean differences between treatments and placebo.
Steroid administration was shown to be consistently effective over the short term but long term the benefit was unclear. For further information the full article can be found here, and the actual paper is here. Read more
“There is a high risk of poor long-term outcomes and higher recurrence rates with corticosteroid injections,” said lead author Bill Vicenzino, chair of sports physiotherapy in the School of Health and Rehabilitation Sciences at the University of Queensland.
“Other treatments, including exercise, some specific physiotherapy and possibly some other injections, should be used before corticosteroid injections,” Vicenzino said.
A critical review by L.Viola of the literature showed some evidence of increased effectiveness of medical acupuncture over steroid injection, however the study sample quoted was limited and further research is required with larger samples.
A study by Val Jones published in Shoulder and elbow concluded that Acupuncture is frequently used by Chiropractors, physiotherapists in the management of chronic tennis elbow . However, the very few acupuncture studies to date have failed to prove conclusively that the short term relief in pain seen gives rise to long term functional improvement. No trials to date have assessed, concentrated or commented on the potential adverse effects of this particular form of treatment. The most recentCochrane review concludes there is insufficient evidence to support or refute the use of acupuncture. Further trials utilizing appropriate methodology and adequate sample sizes are needed before firm conclusions can be drawn regarding this treatment modality.
In my opinion which is based solely on anecdotal cases, there is definitely a role for medical acupuncture in relieving short-term pain over general soft-tissue therapy alone. However it is likely that the combination of supportive taping, clasps, acupuncture, ice and heat therapy plus mobilisation and manipulation is probably the best route of care. This is due to the stimulation of repair, control of inflammation and restoration of accurate controlling reflexes.
From a personal view point just today I have been self administering acupuncture for a strain on my very own Tennis elbow, now I have to be disciplined and not play tennis tonight, pity as I was just starting to perfect my top-spin forehand, (probably wasn’t perfected, hence the injury). Physician heal thyself!!